Search every guide, condition page, and common question.

    Question

    Can your eyes be too dry for scleral lenses?

    Some of the people who rely most on scleral lenses make almost no tears of their own. Others with very dry eyes struggle. Here's what tends to make the difference.

    By the Scleral Lens Team · Last reviewed October 2, 2026 · 6 published sources cited

    The short answer

    Rarely in the sense of being ruled out: people who make almost no tears, and people with heavy oil-gland loss, wear scleral lenses every day. But very dry eyes make the lenses harder work. The front of the lens can dry and smear, fogging is common, and the lids and the white of the eye outside the lens can still feel dry. Many need extra treatment alongside the lens, and some don't get on with lenses at all.

    Key points

    • Very low tear production doesn't by itself rule out scleral lenses.
    • The lens protects the cornea it covers. It doesn't make more tears.
    • Front-surface drying, fogging and lid friction are what usually limit wear.
    • Many very dry eyes need plugs, prescription drops or other treatment as well.
    • An experienced fitter and a second opinion matter before you give up.

    Why very dry eyes can still wear scleral lenses

    Dry eye isn’t one thing. The international TFOS DEWS II report describes two main types, low tear production (aqueous deficient) and too-fast evaporation (evaporative), and treats them as a continuum, with elements of both often present.[1]

    A scleral lens doesn’t depend on your tears to keep the cornea wet. It holds its own reservoir of saline against the cornea, shields it from the environment, helps prevent it drying out, and reduces the rubbing effect of blinking. The same review is clear that the lens does not address the underlying causes of dry eye.[2]

    That’s why people with almost no tears, and people who have lost most of their oil glands, can wear scleral lenses. Wearers with Sjögren’s, graft-versus-host disease, Stevens-Johnson syndrome and severe MGD are among those who describe them as life changing. See Sjögren’s syndrome and severe dry eye for those conditions in detail.

    What tends to limit wear

    The cornea under the lens is protected. Everything else still depends on your tear film:

    • The front of the lens can dry, turn sticky or smear within minutes when there’s little tear film to spread over it. Wearers with near-zero tear production describe the lens surface blurring and blinking becoming uncomfortable.
    • Fogging. In a survey of people with dry eye disease, 75% (50 of 67) of scleral lens wearers who answered reported midday fogging or clouding of vision.[5]
    • The lids. Eyelid problems are common in scleral lens wearers. In one study, eyes being treated for eye surface disease were more likely than eyes with an irregular cornea to have no oil that could be expressed from the glands: 39% (7 of 18) against 11% (3 of 27).[3]
    • The white of the eye outside the lens edge, and the corners, can still dry and burn. See why the uncovered parts of the eye still burn.
    • Nerve pain. When the nerves themselves are sending pain signals, a lens may help less. See neuropathic corneal pain.

    What tends to help

    What wearers with very dry eyes most often report, all agreed with their fitter or eye doctor:

    • Closing the tear ducts. Plugs or cautery are the step several wearers credit with making lenses tolerable.
    • Fill changes. Switching between buffered and unbuffered saline, or adding a preservative-free thicker drop to the fill on a fitter’s advice. See filling solutions.
    • A surface coating to help the front of the lens stay wet, though some very dry wearers find it wears off faster than they’d like.
    • Lens size and design. Larger, impression-based or PROSE devices worked for some after standard lenses didn’t. Others did better with a smaller lens. There’s no rule.
    • Treatment off the lens: prescription anti-inflammatory drops, serum tears, lid care, and protecting the eyes from wind and dry air.

    Not everyone succeeds

    In a specialist clinic’s series of 212 patients evaluated for scleral lenses for eye surface disease, 115 completed the fitting process.[4] That was one tertiary center, and people stop for many reasons, but it’s a reminder that not every fitting ends in daily wear.

    Wearers’ stories reflect this. Some went through several pairs and fitters before finding relief. A few with very dry eyes found the lenses made their eyes feel drier and went back to glasses, sometimes doing well after tear duct closure. If lenses don’t work out, see what if scleral lenses don’t work for me.

    What to ask your fitter

    • What type of dry eye do I have, and how severe is it?
    • Should I treat my tear ducts, lids or inflammation before we start?
    • How much experience do you have fitting severe dry eye?
    • What will we try if the front of the lens dries too fast?
    • How many lenses and visits are included in the fitting?

    For dry eye treatment in general, see our sister site 1-800-dry-eyes.com.

    Common questions

    My Schirmer score is near zero. Is it worth trying?

    Many wearers with scores near zero say yes, and some describe scleral lenses as what let them keep working. Others with very low scores found the front of the lens dried too fast to be comfortable. A fitting with an experienced specialist is the only way to find out for your eyes.

    One fitter told me my eyes are too dry. Should I get a second opinion?

    Wearers commonly recommend it, especially from a fitter who sees a lot of severe dry eye or a center that offers PROSE or impression-based lenses. Some people told no by one practice did well elsewhere. A second opinion can also confirm that sclerals aren't the right tool, which is useful to know too.

    Should I get punctal plugs or cautery before a fitting?

    Ask your eye doctor. Several wearers with very low tear production say closing their tear ducts was what finally made lenses comfortable. Wearers report that it doesn't change the lens fit, though you may need a short break from lenses while the eye heals.

    Will I still need drops?

    Probably, at least some of the time. Many very dry wearers use preservative-free drops over the lens and treatment when the lenses are out. Some find they need fewer drops after a few months of wear.

    Keep reading

    Scleral lenses for severe dry eye: what the research shows

    In people with severe dry eye or ocular surface disease that other treatments haven't controlled, studies find that scleral lenses reduce symptoms, improve vision, and improve quality-of-life scores. But the evidence comes almost entirely from single-clinic case series without comparison groups, often mixing several diseases. People with surface disease seem less likely to keep wearing the lenses long term than people with irregular corneas, and fogging of the fluid layer is a common complaint. For dry eye without other corneal problems, a 2024 review called the evidence sparse.

    Scleral lenses vs punctal plugs

    Punctal plugs are tiny devices placed in the tear drains of the eyelids so your own tears stay on the eye longer. They're quick to put in and can be removed. A scleral lens holds a reservoir of saline over the cornea all day, so it doesn't depend on how many tears you make, and it can also sharpen vision. Plugs are usually tried earlier. Scleral lenses are usually for dry eye that hasn't responded to other treatments. Many people use both. Your eye doctor will advise.

    Scleral lenses vs autologous serum eye drops

    Autologous serum drops are eye drops made from your own blood. They're meant to resemble natural tears more closely than artificial tears do and to support healing of the eye's surface. A scleral lens doesn't treat the surface with anything. It holds a pool of saline over the cornea so it stays wet and shielded from the eyelids all day, and it can also sharpen vision. Serum is a drop routine. A scleral lens is a device to handle. Your eye doctor will decide which, or both, makes sense.

    What is PROSE treatment?

    PROSE is a customized scleral lens treatment from BostonSight, based in Needham, Massachusetts. The device itself is a scleral lens: a gas permeable dome filled with saline that vaults over the cornea and rests on the white of the eye. What sets PROSE apart is its proprietary design software and a structured treatment program with intensive training. It's mainly used for people with severe ocular surface disease or irregular corneas who haven't done well with other options.

    Do scleral lenses help meibomian gland dysfunction (MGD)?

    They can help a lot with symptoms, but they don't treat the glands. A scleral lens keeps your cornea under a layer of saline, so the surface it covers can't dry out between blinks. Your eyelids, their oil glands, and the front of the lens are still exposed to your tear film, so MGD can still cause smeary vision and lid discomfort. Most wearers who do well keep treating their lids alongside the lenses.

    Sources

    1. Craig JP, Nichols KK, Akpek EK, et al. TFOS DEWS II Definition and Classification Report. Ocul Surf. 2017;15(3):276-283. doi:10.1016/j.jtos.2017.05.008 pubmed.ncbi.nlm.nih.gov
    2. Rodriguez-Garcia A, Jimenez-Perez JC, Ruiz-Lozano RE, et al. Scleral lenses and PROSE: indications, complications, and future challenges. Med Hypothesis Discov Innov Ophthalmol. 2025;14(3):73-106. doi:10.51329/mehdiophthal1525 pubmed.ncbi.nlm.nih.gov
    3. Harthan JS, Nau A, Shorter E, Nau CB, Schornack M, Fogt JS. Presence of eyelid disease in habitual scleral lens wearers. J Clin Med. 2026;15(9):3181. doi:10.3390/jcm15093181 pubmed.ncbi.nlm.nih.gov
    4. Schornack MM, Pyle J, Patel SV. Scleral lenses in the management of ocular surface disease. Ophthalmology. 2014;121(7):1398-1405. doi:10.1016/j.ophtha.2014.01.028 pubmed.ncbi.nlm.nih.gov
    5. Shorter E, Nau CB, Fogt JS, Nau A, Schornack M, Harthan J. Patient experiences with therapeutic contact lenses and dry eye disease. Eye Contact Lens. 2024;50(2):59-64. doi:10.1097/ICL.0000000000001051 pubmed.ncbi.nlm.nih.gov
    6. U.S. Food and Drug Administration. Contact Lens Risks. Content current as of September 4, 2018. fda.gov

    Last updated October 2, 2026. Found an error or a newer study? Let us know and we'll correct the page.